Provider Demographics
NPI:1053365270
Name:VERPUKHOVSKIY, YURIY (MD)
Entity type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:VERPUKHOVSKIY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:STE.306
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-904-9200
Mailing Address - Fax:818-904-9300
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:STE.306
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-904-9200
Practice Address - Fax:818-904-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76392207QA0505X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A763920Medicaid
ARA76392OtherLICENSE
CA202824485OtherTAX ID
CAWA76392BMedicare PIN
CA202824485OtherTAX ID
ARA76392OtherLICENSE